Hi Beth,

The salient points to me are thus:

- taking herbs and domperidone (quite a lot if you ask me)
- pumpiing with a rental pump
- has come a long way in terms of supply
- big boy, now approaching 12wks
- pumps 40 -70ml post feed though 40ml is more typical
- average amount takenat breast 18 - 22ml with compressions

You didn't say how often mother pumps, but seeing all she has
done and tried, I would assumeit is after every feed or after most feeds.
I am also assuming that the 40 mls is the total counting both breasts.
So, to me, this is still low production. Babies respond to flow and with
low production the flow is also slow. Yes, baby could certainly figure
out that he can wait for the bottle (I assume that is how she supplements?)
to take the bulk of his feeding.

She can certainly tweak the herbs she is taking, try different ones or
combinations.
She can try different pumps. I personally don't see best results,
anecdotally, with Lactina
as I do with Elite, Classic, or Symphony. She can certainly re-visit
the appropriateness of the flange size, does it need to be changed?

However, she must find a way for her and baby to enjoy the
breastfeeding relationship.
Using a lactation aid at breast, for most feedings
if she can manage and enjoy, would be a way for baby to just stay
at breast for feeds. Mother can continue to pump post-feed or dis-
continue that, in favor of just mothering at the breast.  Has she read
the book Making More Milk (defining her own success)?

Laurie Wheeler RN MN IBCLC
Mississippi USA

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